Whiting: Should 'death with dignity' be law?

Sept. 6, 2013

Updated 7:03 p.m.

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With the World War II generation facing tough medical decisions, baby boomers considering their own mortality and medicine advancing to help us live longer but not necessarily better, the issues surrounding assisted suicide are loaded with emotion, religion and personal beliefs. FILE PHOTO

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Elizabeth Barrett, a 65-year-old woman, was arrested March 28, 2012 on a felony charge alleging she helped a friend kill himself by mixing a lethal drug dose in his yogurt. ORANGE COUNTY SHERIFF'S DEPARTMENT

With the World War II generation facing tough medical decisions, baby boomers considering their own mortality and medicine advancing to help us live longer but not necessarily better, the issues surrounding assisted suicide are loaded with emotion, religion and personal beliefs. FILE PHOTO

Physician confidentiality

Dr. Mike explains why he wants his identity masked: “If it is revealed that I write dignity prescriptions, the relationship with my patients may change and I may not be able to fulfill my primary care provider obligations. Writing these prescriptions is a very small percentage of what I do. Like most physicians, I aim to improve patients' quality of life rather than end life altogether.

“I also hope that one day a patient can ask for death-with-dignity medication and that their doctor will feel comfortable in writing the prescription. That day may take years. But we slow the process if we enable physicians to pass along terminal patients.”

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SOUTHERN OREGON – A physician who's helped 20 people end their lives pauses before answering an intimate question about Oregon's death-with-dignity law.

What do his parents think about what their son does?

The doctor says that his father, a health care professional, and his devoutly religious mother would disapprove if they found out.

And his wife? She understands.

Despite the disturbing and difficult subject, there is much compassion in the air. The doctor easily recalls the names, the reasons and the relatives of each of the aging adults he's prescribed death-with-dignity drugs to over the past decade. Many of their family members remain his patients.

“These people,” the doctor explains, “are very sick and their quality of life is very poor.” He mentions one patient with a lung disease that meant she would eventually suffocate. “That's a miserable way to die.”

Still, Dr. Mike, as I'll call him, speaks with caution. I'm asked to knock on the clinic's back door after hours. And the physician agrees to talk only if his identity is masked. Understand, Oregon is one of a very few states in which dying patients can legally obtain prescriptions to end their lives.

And even in Oregon, the topic remains taboo.

With the World War II generation facing tough medical decisions, baby boomers considering their own mortality and medicine advancing to help us live longer but not necessarily better, the issues surrounding assisted suicide are loaded with emotion, religion and personal beliefs.

A few years ago, a series of suicides by elderly people in Orange County attracted national attention. Locally and nationally, it renewed the debate that had lain relatively dormant since 2005, when a death-with-dignity proposal was rejected by the California Legislature.

As recently as last year, the issue again surfaced when Elizabeth Barrett of Laguna Woods was charged with helping an 86-year-old World War II veteran commit suicide, illegal in California as well as Oregon. Earlier this year, Barrett was sentenced to three years' probation.

The split is so wide over what the Hippocratic Oath means in an era in which we can artificially extend life that an estimated 90 percent of Oregon physicians decline to write death-with-dignity prescriptions, an opt-out the law allows.

The physician who sits before me in one of the many small towns that dot this state also used to dodge filling out requests for end-of-life medications.

“These are tough decisions,” the doctor allows. “I've accepted this. Sometimes it's your role as a physician to comfort patients in their final days.”

One of the complexities in evaluating death-with-dignity laws is that unsanctioned assisted suicide has been happening for centuries. In close-knit communities, family doctors once helped patients die. On battlefields, buddies used to help mortally wounded soldiers pass more quickly.

But this is a century of greater regulation. Today, medical professionals quietly slip out of hospital rooms and leave family members with fatal doses of morphine and a dying loved one in pain.

If assisted suicide already is occurring, why do we need death-with-dignity laws?

Barrett's is a case in point. Without guidelines, well-meaning individuals can go astray. Dr. Mike tells me he's comfortable with Oregon law and is uncomfortable with anything less.

Ending your life, Dr. Mike emphasizes, isn't about pain management. “Some suffering should be expected at the end of our lives.”

Accordingly, he adds, family members should expect to emotionally share the pain, something the physician calls “the burden of love.”

Physician-assisted suicide in Oregon requires patients be of sound mind, that they make the request on their own and that they have a terminal illness that will end life within six months. Two witnesses must be present when they sign a document. Two physicians must agree on the diagnosis. Finally, there is a 15-day waiting period before a prescription can be written.

Last year, 115 Oregonians received prescriptions; 77 used them. Oregon's total population is less than a third larger than Orange County's.

In a determined departure from Dr. Kevorkian-like practices, the patient – not the doctor – is responsible for administering the medication.

Dr. Mike allows that he's never attended a patient's death. At first, his decision sounds cold. But the physician explains that simply his presence can act like peer pressure.

“I give them every chance to change their mind,” he says. “I want to be sure it's the patient's decision and theirs alone.”

The case that caused Dr. Mike to start prescribing death-with-dignity meds involved an 84-year-old man with a variety of ailments including congestive heart failure. The man wanted to die, and the physician admits, “I came up with all kinds of excuses” to avoid prescribing lethal medication.

One night the man's wife called. Dr. Mike arrived at the couple's apartment. His patient's legs were oozing fluid. The doctor asked himself, “Is this what this man's life has come to?”

But what if someone takes his life and there's a miracle cure just around the corner?

Dr. Mike looks at me soberly and explains the reality of so-called miracle cures. He shakes his head and adds, “I've been practicing medicine for 20 years.”

Would he take a lethal dose himself? The doctor stares at the floor. Looking up, he says it's unlikely. Then he reconsiders. He might if, for example, he had terminal pancreatic cancer.

The exercise points out how difficult it is to predict what you would do if hit with horrific pain and terminal illness.

We discuss other professionals who help manage pain and end-of-life challenges, including those involved with hospice and palliative care, the relief of pain. The physician smiles thinking of the nurses who work in hospice, calling them masters. Still, Dr. Mike maintains there's a growing need for death-with-dignity laws.

“I think the demand is going to go up as we age as a society.”

My review of Orange County suicides last year finds 11 men and women over the age of 85. I don't know how many had terminal illnesses. But I do know most died violently and alone.

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